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Somnambulism

Sleepwalking


Presentation

  • Abstract We present a case involving a 66-year-old woman with a history of childhood somnambulism who presented with a recent recurrence of sleepwalking.[ncbi.nlm.nih.gov]
Nocturnal Awakening
  • Subjects used logs to record "lights out" time, "lights on" time, nocturnal awakenings, and other events that occurred during the night.[ncbi.nlm.nih.gov]
  • Subjects used logs to record “lights out” time, “lights on” time, nocturnal awakenings, and other events that occurred during the night.[doi.org]
  • NES is characterized by consumption of excessive amounts of food either before bed or during nocturnal awakenings.[emedicine.medscape.com]
Malingering
  • Establishing a legal defense for parasomnia will prove difficult due to the strong potential for malingering, so specific criteria will be outlined in order to distinguish between true and fraudulent claims of crimes committed during parasomniac states[ncbi.nlm.nih.gov]
  • Less commonly, SW can appear in the context of nocturnal epilepsy, parasomnia overlap disorder—in which rapid eye movement (REM) and NREM features are combined, and malingering.[doi.org]
  • Because these sleepwalking behaviours occur without volition, sleepwalking can be used as a legal defense.Alternative explanations, such as malingering and alcohol and drug-induced amnesia, need to be excluded.[en.wikipedia.org]
Abnormal Breathing
  • The preceding recording segment (left side of figure) shows the abnormal breathing that occurred during SWS. The abnormal breathing can be seen on the nasal cannula/pressure transducer recording (Cannula).[doi.org]
Hoarseness
  • He said his actions must have taken place during a confused arousal caused by his severe sleep apnea in which patients stop breathing during sleep and them suddenly restart breathing with a hoarse snore.[lakesidepress.com]
Choking
  • Sleep-disordered breathing, including a sense of choking or blocked breathing, has also been reported. The respiratory events may have a deleterious effect on sleep by increasing arousals and sleep fragmentation.[emedicine.medscape.com]
  • He then beat his mother-in-law to death and choked his father-in-law. Now a blood-spattered mess covered in cuts and bruises, he drove to a nearby police station. In a confused manner, he told the police that he “thought” he killed someone.[doi.org]
Mouth Breathing
  • Thirty-six prepubertal children (19 girls) with parental report of at least 8.5 hours of nightly sleep, absence of known daytime consequences of sleep disorders (eg, daytime sleepiness, cataplexy, hyperactivity, morning headache, mouth breathing), and[doi.org]
Behavior Problem
  • However, zolpidem-induced somnambulism and amnesic sleep-related behavioral problems were begun to be reported in literature but no systemic investigation has been undertaken in non-Western cultures.[ncbi.nlm.nih.gov]
  • To explore what might precipitate sleep terrors and sleepwalking in children, we performed a retrospective analysis of clinical and polysomnographic data from 84 prepubertal children, aged 2 and 11 years, who were referred for these behavioral problems[doi.org]
Nocturnal Seizure
  • Comorbid conditions Medical conditions associated with parasomnias include the following: Arrhythmias Fever Gastroesophageal reflux Nocturnal asthma Nocturnal seizures Obstructive sleep apnea - Children with obstructive sleep apnea or Tourette syndrome[emedicine.medscape.com]
Automatic Behavior
  • Most episodes arise from slow-wave sleep and are characterized by relative unresponsiveness to external stimuli, mental confusion, automatic behaviors, and variable retrograde amnesia.[oxfordhandbooks.com]
Morning Headache
  • Thirty-six prepubertal children (19 girls) with parental report of at least 8.5 hours of nightly sleep, absence of known daytime consequences of sleep disorders (eg, daytime sleepiness, cataplexy, hyperactivity, morning headache, mouth breathing), and[doi.org]

Workup

  • […] and physical examination Electroencephalography (EEG) may be helpful; microarousals and sleep state disorganization are often noted on EEG done during nocturnal sleep See DDx and Workup for more detail.[emedicine.medscape.com]
  • Six to 7 months after the initial visit, reevaluation included the same clinical workup as at entry, review of the sleep logs obtained at the previous follow-up visits, and review of the nocturnal polysomnograms.[doi.org]
EEG Slowing
  • OBJECTIVE: The sleep structure and the dynamics of EEG slow-wave activity (SWA) were investigated in 12 young adults and age- and gender-matched controls.[ncbi.nlm.nih.gov]

Treatment

  • A variety of treatments have been recommended, but well-designed controlled clinical trials are lacking.[oxfordhandbooks.com]
  • In the absence of clinical trials, tentative, low-risk treatments - scheduled waking and hypnosis - are suggested for sleepwalking that results in distress or violence towards others.[ncbi.nlm.nih.gov]

Prognosis

  • Prognosis The NREM parasomnias are rarely associated with any significant morbidity or long-term sequelae.[emedicine.medscape.com]

Etiology

  • The diagnosis of somnambulism was confirmed polysomnographically and linked etiologically to the start of using metoprolol, a lipophilic beta-blocker, for treating her hypertension.[ncbi.nlm.nih.gov]
  • This chapter discusses the clinical presentation, etiology, polysomnographic findings, diagnostic considerations, prevalence, and treatment options associated with these two parasomnias. Sleepwalking and sleep terrors share many characteristics.[oxfordhandbooks.com]
  • Etiology Genetic factors Sleepwalking occurs more frequently in monozygotic twins and is 10 times more likely if a first-degree relative has a history of sleepwalking. An increased frequency of DQB1*04 and *05 alleles is reported.[emedicine.medscape.com]

Epidemiology

  • Further epidemiological research that addresses methodological problems found in studies of sleepwalking to date is needed.[ncbi.nlm.nih.gov]
  • Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Epidemiology. 2007;18(6):805–35. pmid:18049195 View Article PubMed/NCBI Google Scholar 23.[doi.org]
  • Lynskey, Genetic Epidemiology of Liability for Alcohol‐Induced Blacking and Passing Out, Alcoholism: Clinical and Experimental Research, 43, 6, (1103-1112), (2019). Samuel F. Acuff, Andrew T. Voss, Ashley A. Dennhardt, Brian Borsari, Matthew P.[dx.doi.org]
  • Psychiatric disorders associated with parasomnias include the following: Epidemiology United States and international statistics Disorders of arousal are all more prevalent in children than in adults.[emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • BACKGROUND: Despite its high prevalence, relatively little is known about the pathophysiology of somnambulism.[ncbi.nlm.nih.gov]
  • Somnambulism: clinical aspects and pathophysiological hypotheses. Lancet Neurol. 2013;12(3):285-294. PMID: 23415568 www.ncbi.nlm.nih.gov/pubmed/23415568. Updated by: Amit M.[nlm.nih.gov]
  • The co-occurrence of SW and RBD in most of our patients raises 2 possible pathophysiologic explanations.[doi.org]

Prevention

  • But precautions should be taken to prevent injuries such as falling down stairs or climbing out of a window. You probably do not need to visit your provider.[nlm.nih.gov]
  • In addition, they should undergo appropriate treatment and management in order to prevent future parasomnia behaviors.[ncbi.nlm.nih.gov]
  • Or perhaps you might just read Epstein’s article to them, which will not only scare the bejeebers out of them, but probably prevent them from sleeping at all. Ken Send questions to Cecil via cecil@straightdope.com.[straightdope.com]

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